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PG038, Pre-admission Services

August 25, 2010

Dear Outpatient Behavioral Health Agency Providers:

* The following information applies only to OPBH agencies. If you are an individually contracted licensed practitioner in a private practice setting, this correspondence does not pertain to you.

Pre-admission services – PG038 steps and procedures are described in the following list:

In CareConnection®, submission of Section One which is Transaction Type 21 on the Customer Data Core (CDC) is required for all outpatient behavioral health agencies.
Once the CDC Transaction Type 21 has been submitted in CareConnection® an instant authorization number for the Pre-admission Services (PG038) will be issued. The start date of the authorization will be the Transaction Date listed on the CDC.
The CDC section one (Transaction Type 21) can be submitted in CareConnection® up to seven days after the date of the first appointment (transaction) with the member/customer. The Pre-admission Services authorization is the only time that a retroactive authorization can be issued.
The length of the authorization for PG038 is 30 days. The end date of PG038 can be extended if needed.
PG038 includes the initial assessment code (H0031) and Service Plan Development code (H0032).
The maximum benefit amount for PG038 is $483.00. This total of $483.00 includes the assessment (H0031) and the Service Plan Development (H0032).
The Pre-admission Services, Procedure Code Group PG038 has a listing of procedure codes which can be used as clinically appropriate and medically necessary. Daily limits still apply. The procedure codes in the Pre-Admission services can be utilized in any order and frequency.
The services listed as Pre-admission Services can be located at http://www.soonerpro.com/Resources/Manuals.aspx under Outpatient (“Procedure Code Groups”).
Once the Initial Prior Authorization Request has been approved in CareConnection®, the PG038 will be end dated. The PG038 will end date the day prior to the start of the initial prior authorization request.
For SoonerCare, a completed initial assessment and a valid service plan are required before providing any of the services approved in the initial request for treatment authorization (level of care procedure code groups).